Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e718-e730 (doi:10.1542/peds.2007-1280)
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ARTICLE

Impact of Admission-Day Crowding on the Length of Stay of Pediatric Hospitalizations

Scott A. Lorch, MD, MSCEa,b,c, Andrea M. Millman, BAb, Xuemei Zhang, MSb, Orit Even-Shoshan, MSb,c and Jeffrey H. Silber, MD, PhDb,c,d

a Division of Neonatology, Department of Pediatrics
b Center for Outcomes Research
d Departments of Pediatrics and Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
c Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania

OBJECTIVE. Increased crowding may affect the care that is delivered to hospitalized patients, particularly around the time of admission. There is little information about the impact of admission-day crowding on the outcome of children who are hospitalized with common pediatric conditions.

METHODS. A population cohort was constructed of children who were aged 1 to 17 years and were hospitalized in Pennsylvania and New York between April 1, 1996, and June 30, 1998, with 1 of 19 common pediatric conditions (N = 116235). Condition-specific Cox regression and logit models were developed to estimate the effect of admission-day occupancy on 4 outcome measures after controlling for illness severity and site of care: length of stay; 21-day readmission; prolonged stay or a stay longer than the typical, uncomplicated stay for that condition as a measure of care delivered to patients with uncomplicated courses; and conditional length of stay as a measure of care delivered to patients whose stays are prolonged.

RESULTS. For children who were admitted with respiratory disease, increasing admission-day occupancy from 60% to 100% was associated with a 0.25-day increase in the average length of stay. Increased admission-day occupancy above 60% was also associated with higher odds of a prolonged stay but not with a change in 21-day readmission rates or conditional length of stay. For children who were admitted with nonrespiratory conditions, increased admission-day occupancy was not associated with changes to any length-of-stay outcome.

CONCLUSIONS. Increased admission-day occupancy was associated with longer lengths of stay for less complicated respiratory admissions but not for children who were admitted with the most serious conditions. These results suggest that medical professionals, during times of increased workload, first focus their attention on more acutely ill children with a complicated course and thus delay treatment of children who have less complicated courses but require time-consuming management and treatment.

Key Words: hospital crowding • length of stay • pediatric hospitalizations

Abbreviations: LOS—length of stay • IQR—interquartile range • OR—odds ratio • CLOS—conditional LOS • HR— hazard ratio

Accepted Sep 5, 2007.